Perioperative antiplatelet therapy in intracranial aneurysms: meta-analysis of high-quality randomized clinical trials

BACKGROUND: The use of antiplatelet therapy (APT) during the perioperative period in patients with intracranial aneurysms (IA) to prevent thrombosis and reduce postoperative complications remains debated. This study evaluates the safety and efficacy of initiating APT in IA patients during the perioperative period. METHODS: A systematic review and meta-analysis of high-quality randomized clinical trials (RCTs) on perioperative APT in IA patients was performed. A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. Efficacy outcomes included ischemic stroke (IS), thromboembolic events, delayed cerebral ischemia (DCI), and symptomatic cerebral vasospasm (SCV), while safety outcomes included intracranial hemorrhage (ICH), hemorrhagic events (HE), prognosis. RESULTS: Ten RCTs involving 1,862 patients were included. The meta-analysis demonstrated that perioperative APT significantly reduced the incidence of ischemic stroke (PR, 5%, 95% CI, 2%-8%, p < 0.001), thrombosis (PR, 2%, 95% CI, 1%-3%, p < 0.001), DCI (PR, 20%, 95% CI, 15%-27%, p < 0.001), and SCV (PR, 14%, 95% CI, 9%-19%, p < 0.001). However, APT did not significantly increase the incidence of ICH (PR, 1%, 95% CI, 0%-3%, p = 0.048) or HE (PR, 4%, 95% CI, 2%-5%, p < 0.001). Additionally, APT was not associated with an increased risk of poor functional outcomes within 3 months (PR, 11%, 95% CI, 7%-16%, p < 0.001). CONCLUSION: This meta-analysis suggests that initiating APT during the perioperative period in IA patients effectively reduces the occurrence of IS, thromboembolic events, DCI, and SCV, without significantly increasing bleeding risks.